Publication Stage Representation Form
Please return to Hart District Council - either email this response to or send it to Planning Policy, Hart District Council, Harlington Way, Fleet, GU51 4AE by 4pm, 26 March 2018.
This form has two parts-
Part A – Personal Details. This need only be completed once.
Part B - Your Representation (s). Please fill in a separate sheet for each representation you make.
Part A: Respondent Details
- Personal Details*
- Agent’s Details (if applicable)
*If an agent is appointed, please complete only the Title, Name and Organisation boxes below but complete the full contact details of the agent in 2.
TitleFirst name
Last Name
Job Title
(where relevant)
Organisation
(where relevant)
Address Line 1
Line 2
Line 3
Line 4
Post Code
Telephone Number
Email Address (where relevant)
The information collected as part of this consultation will be processed by the Council in accordance with the Data Protection Act 1998. The purposes for collecting this data are to:
- contact you to acknowledge receipt of any representations that you make
- seek further information regarding the information provided in your representation (where necessary) and
- forward your comments to an independent inspector whose role is to assess whether the plan has been prepared in accordance with the Duty to Cooperate, legal and procedural requirements, and whether it is sound (see paragraph 131 of the National Planning Policy Framework).
Signed / Date
Please check this box if you would like your details to be retained
by Hart District Council for future Local Plan consultations or updates ☐
Equality monitoring questions
Please note that these fields are not mandatory. The information that you provide below will help us identify which different demographic groups have engaged with this consultation.
How would you describe your ethnic group?
☐ White
☐ Mixed or Multiple Ethnic Groups
☐ Asian or Asian British
☐ Black or Black British
☐ Other – please specify.
☐ I would rather not answer
If White please complete:
☐ White British
☐ White Irish
☐ White Traveller (including Gypsy, Roma or Irish traveller)
☐ Other White background
If Mixed or Multiple Ethnic Groups please complete:
☐ White and Asian
☐ White and Black African
☐ White and Black Caribbean
☐ Other Mixed background
If Asian or Asian British please complete:
☐Nepalese
☐ Bangladeshi
☐ Indian
☐ Pakistani
☐ Chinese
☐ Other Asian background
If Black or Black British please complete:
☐ African
☐ Caribbean
☐ Other Black background
Do you consider yourself to have a disability as defined by the Disability Discrimination Act 1995 (2005)?
Definition: A person has a disability for the purposes of this Act if s/he has a physical or mental impairment, which has a substantial and long-term adverse effect on her/his ability to carry out day-to-day activities.
☐Yes
☐ No
☐ Don’t know
☐ I would rather not answer
What is your gender?
☐ Male
☐ Female
☐ I would rather not answer
In which age category are you?
☐ Under 18
☐ 18 – 24
☐ 25 – 34
☐ 35 – 44
☐ 45 – 54
☐ 55 – 64
☐ 65 – 74
☐ 75 +
☐ I would rather not answer
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